Let’s talk about the elephant in the room.
Emergency Room travel nurses don’t always give great reports. Before you stop reading this because you think I’m a floor nurse offering advice to ER folks, you should know something first. I am an ER nurse myself. However, I have reformed! I’ve repented and asked for help! After years of bad reports, I’m here to spread the good news. We can change!
Without further ado, here it is.
Before report
1) Actually, look at your labs – not just the initial troponin or d-dimer. Review previous lab values if possible. Identify significant changes and correlate data.
2) Review diagnostics tests. Even if they are negative.
3) Review your medication administration times, dosages, and response.
4) Update and review vital signs. If you work in a contemporary ER, this is as easy as the click of a button. Stable vital signs prove stability. This is your single most objective piece of data.
5) Correlate relevant data in a systems approach. Respiratory: CT scan, chest x-ray, vent settings, rate rhythm, lung sounds, ABGs. Cardiovascular: troponin, EKG, rhythm, periph vascular, edema, JVD, ejection fraction, opqrst!
6) Take notes and organize.
Giving report
Now that you have your objective data organized, consider who you are going to talk to.
- The ICU travel nurse wants the facts and a funny story.
- The step-down travel nurse wants to know how often they have to titrate a drip.
- The med surg travel nurse wants to know if this person got lactulose and can make it to the bathroom.
- Be considerate and love on your compadres. We all have different priorities!
Now you are on the phone. Remember, you are an ER travel nurse. You are a maverick in an F-14. You were flying inverted above the MIG, and you saw the Russian jet upside down and took a selfie. Calm down. We know you are awesome.
1) The more you say, “uhhhhhh… lemme look that up,” the less prepared you are.
2)Provide a brief history of relevant meds, surgeries, and medical history. Let the pharmacy or admitting do the med rec.
3) Know your work up! If it was a cardiac workup that was a slam dunk, for example, chest pain MI, own it! If it was a “chest pain” that ended up being pancreatitis, explain it.
4) Provide report in a systems approach. Neuro, respiratory, cardiovascular. Hit the big three with a comprehensive approach. Correlate body systems with corresponding labs, diagnostic, assessment findings, medications, and vitals.
5) Be honest. Either the IV is good, bad, or ugly.
6) If you have something to say about the patient, i.e. they are difficult, try to frame it in a positive but objective way. The receiving nurse will understand.
What to do if you can’t provide report?
1) Be cool. If you can’t provide report because the floor is busy, don’t vilify the receiving nurse.
2) Don’t call the receiving floor’s charge without escalating to your own first. This shows you don’t understand the chain of command.
3) Look at your capacity management for the day. Is the ICU at capacity? Is the cardiac floor short a nurse because someone floated to the ER to board ER patients? See the bigger picture and let your charge nurse fight these problems.
4) If you are holding a patient and they need to move ASAP, communicate this. Your CHF patient on Lasix might be an inconvenience but what about the guy on bi-pap in pod three with terrible ABG’s? You may not always see the bigger picture.
Conclusion
If you have read this far, I applaud you. Remember to keep it classy when you give report. Get your stuff together before calling the receiving nurse. Take 5-10 minutes and gather info. Take notes.
By doing this, you will reduce erroneous questions, transfers to higher acuity floors, and bed delays. ER, workflow is divided into three components: input, throughput, and output.
If you are struggling with output and disposition to patient transfer, you may want to consider why the floor is slow to accept your patient. It may simply be a bad report.
We hope you found these tips helpful! Interested in travel nursing or looking for your next assignment? Try our job page or our Facebook jobs group!
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